The proposed research is concerned with two basic problems in the area of health care services as they pertain to Appalachian migrants in urban centers outside the Appalachian region: 1) the quality of health care services generally available to Appalachian migrants is frequently below the accepted standard for the more affluent sectors of the community; and 2) health care services are frequently less available to the Appalachian migrant population, and/or are utilized less often and less efficiently by that group than by other sectors of the urban population. The principal investigator, Project Director, and three Research Assistants will approach the problem of health care delivery to the Appalachian subgroup from two viewpoints: that of the Appalachian migrant himself, and that of the health care service agency. Research will determine what health service resources are available to the Appalachain migrant, the degree to which they are utilized, the barriers which inhibit fuller utilization, and the quality of care received by Appalachain migrants. Interviews, questionnaires, observations, and other methods of analysis will yield data ultimately leading to the development of specific recommendations for increasing both the utilization of services and the quality of care. Prior contacts with social service agencies and medical service agencies will be made to insure that there will be cooperation in carrying out the proposed reseach, and interest in the findings. A final report will be published and distributed to contributing agencies, indicating the extent to which health service access, utilization and quality of care for the Appalachian migrant are lower than for the standard (middle class) population, and suggesting possible programs to correct these problems.